Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function

Abdelkader Boukhmis; Mohammed El-Amin Nouar; Yacine Djouaher

doi:doi:10.11648/j.ijcts.20230903.11

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Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function

Abdelkader Boukhmis, Mohammed El-Amin Nouar, Yacine Djouaher

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 9, Issue 3)

Received: 15 March 2023 Accepted: 3 April 2023 Published: 10 June 2023

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Abstract

Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 9, Issue 3)
DOI	10.11648/j.ijcts.20230903.11
Page(s)	22-26
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Heart Failure, Dilated Cardiomyopathy, Mitral Regurgitation, Beating Heart

References

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APA Style

Abdelkader Boukhmis, Mohammed El-Amin Nouar, Yacine Djouaher. (2023). Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. International Journal of Cardiovascular and Thoracic Surgery, 9(3), 22-26. https://doi.org/10.11648/j.ijcts.20230903.11

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ACS Style

Abdelkader Boukhmis; Mohammed El-Amin Nouar; Yacine Djouaher. Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. Int. J. Cardiovasc. Thorac. Surg. 2023, 9(3), 22-26. doi: 10.11648/j.ijcts.20230903.11

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AMA Style

Abdelkader Boukhmis, Mohammed El-Amin Nouar, Yacine Djouaher. Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. Int J Cardiovasc Thorac Surg. 2023;9(3):22-26. doi: 10.11648/j.ijcts.20230903.11

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@article{10.11648/j.ijcts.20230903.11,
  author = {Abdelkader Boukhmis and Mohammed El-Amin Nouar and Yacine Djouaher},
  title = {Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {9},
  number = {3},
  pages = {22-26},
  doi = {10.11648/j.ijcts.20230903.11},
  url = {https://doi.org/10.11648/j.ijcts.20230903.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20230903.11},
  abstract = {Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.},
 year = {2023}
}

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TY  - JOUR
T1  - Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function
AU  - Abdelkader Boukhmis
AU  - Mohammed El-Amin Nouar
AU  - Yacine Djouaher
Y1  - 2023/06/10
PY  - 2023
N1  - https://doi.org/10.11648/j.ijcts.20230903.11
DO  - 10.11648/j.ijcts.20230903.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 22
EP  - 26
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20230903.11
AB  - Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.
VL  - 9
IS  - 3
ER  -

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Author Information

Abdelkader Boukhmis

Department Corresponding to the Working Group, Department of Cardiac Surgery, University Hospital Center Mustapha, Algiers, Algeria
Mohammed El-Amin Nouar

Department Corresponding to the Working Group, Department of Cardiac Surgery, University Hospital Center Mustapha, Algiers, Algeria
Yacine Djouaher

Department Corresponding to the Working Group, Department of Cardiac Surgery, University Hospital Center Mustapha, Algiers, Algeria

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APA Style

Abdelkader Boukhmis, Mohammed El-Amin Nouar, Yacine Djouaher. (2023). Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. International Journal of Cardiovascular and Thoracic Surgery, 9(3), 22-26. https://doi.org/10.11648/j.ijcts.20230903.11

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ACS Style

Abdelkader Boukhmis; Mohammed El-Amin Nouar; Yacine Djouaher. Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. Int. J. Cardiovasc. Thorac. Surg. 2023, 9(3), 22-26. doi: 10.11648/j.ijcts.20230903.11

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AMA Style

Abdelkader Boukhmis, Mohammed El-Amin Nouar, Yacine Djouaher. Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function. Int J Cardiovasc Thorac Surg. 2023;9(3):22-26. doi: 10.11648/j.ijcts.20230903.11

Copy | Download

@article{10.11648/j.ijcts.20230903.11,
  author = {Abdelkader Boukhmis and Mohammed El-Amin Nouar and Yacine Djouaher},
  title = {Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {9},
  number = {3},
  pages = {22-26},
  doi = {10.11648/j.ijcts.20230903.11},
  url = {https://doi.org/10.11648/j.ijcts.20230903.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20230903.11},
  abstract = {Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.},
 year = {2023}
}

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TY  - JOUR
T1  - Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function
AU  - Abdelkader Boukhmis
AU  - Mohammed El-Amin Nouar
AU  - Yacine Djouaher
Y1  - 2023/06/10
PY  - 2023
N1  - https://doi.org/10.11648/j.ijcts.20230903.11
DO  - 10.11648/j.ijcts.20230903.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 22
EP  - 26
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20230903.11
AB  - Background: Ischemic cardiomyopathy patients often have a severely atherosclerotic ascending aorta and low cardiac function. In these patients, aortic cross-clamping and cardiac arrest increase the risk of postoperative strokes and low cardiac output syndrome. Objective: To evaluate the short and medium term outcomes of clampless beating heart mitral valve replacement in patients with secondary mitral regurgitation and a poor left ventricular function. Method: Here we describe two male patients, aged 71 and 54 years, with severe secondary mitral regurgitation and impaired left ventricular ejection fraction (LVEF) (24% and 30%, respectively). On-pump beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping, through a full sternotomy approach. Results: Weaning from cardiopulmonary bypass, which lasted 43 and 52 minutes respectively, was easily achieved without the use of positive inotropes or vasopressors. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short, considering the advanced stage of cardiomyopathy. Both patients had no postoperative neurological disorder. After a mean follow-up of 66 months (84 and 48 months, respectively), both patients were asymptomatic, without prosthetic valve dysfunction and their LVEF reached 42% and 51%, respectively. Conclusion: Beating heart mitral valve replacement, with total preservation of subvalvular apparatus, and without cross-clamping of the aorta, preserves left ventricular systolic function in the short and long-term, and reduces embolic events due to aortic manipulation. This technique can improve the outcomes of surgery for secondary mitral regurgitation in cases of severe left ventricular dysfunction.
VL  - 9
IS  - 3
ER  -

Copy | Download